Endoscopic surgery includes thoracic or abdominal surgery performed under the monitoring of images from an endoscope (e.g., thoracoscope or laparoscope) inserted in a thoracic or abdominal cavity. In laparoscopic surgery, for example, unlike traditional abdominal surgery (laparotomy), incisions in the abdomen are not large, and operations are performed using several necessary small-diameter (about 5 to 15 mm) tubes (trocars) which are inserted in the abdomen and through which a laparoscope and small forceps (an instrument used for grasping or holding an organ) developed for endoscopic surgery are put in and out. In order to perform the surgery under careful observation of the abdominal cavity, carbon dioxide gas is also insufflated into the abdominal cavity to inflate the abdomen (called pneumoperitoneum) or to elevate the abdominal wall.
As compared with laparotomy, endoscopic surgery has advantages such as:
small incision, cosmetically good result, and less pain after surgery; and
the effect of magnification by laparoscope, which makes possible delicate techniques with less bleeding.
Thanks to the low invasiveness, endoscopic surgery has made remarkable progress.
However, endoscopic surgery has the following problems.
Once bleeding occurs, the endoscopic field is degraded, and hemostasis is more difficult than in laparotomy.
Carbon dioxide gas is usually injected into the abdominal cavity for pneumoperitoneum. Therefore, when exudates and blood are sucked during surgery, abdominal gas (CO2) is simultaneously sucked, so that the endoscopic field can be difficult to maintain, which makes suction more difficult than in laparotomy.
In two-dimensional monitoring, it is difficult to monitor organs in the deep field, which creates the risk of damage to organs.
Organs cannot be directly touched by hand and fingers, and operations are performed using hard forceps, which makes it difficult to protectively treat organs.
These problems are common to all endoscopic operations of abdominal organs, which include operations in the field of not only digestive surgery but also gynecology and urology.
These problems, which are not significant for usual laparotomy, are unique to endoscopic surgery. In usual laparotomy, for example, bleeding can be stopped by holding gauze or the like directly to the bleeding part, and it is easy to replace the gauze with new gauze one after another. In usual laparotomy, pneumoperitoneum is not necessary, and organs can be directly observed with no monitor, and therefore, a sufficient visual field is ensured. In laparotomy, organs can be treated directly by hand and fingers, so that protective exclusion or protection of organs is possible. As described above, the problems with endoscopic surgery are not significant for laparotomy with a long history, and therefore, there is no medical device capable of solving the problems found in the medical devices for laparotomy.
Examples of organ exclusion or traction instruments for endoscopic surgery include a triangle retractor (Stemmer, Germany) and a retractor (e.g., manufactured by MIZUHO Co., ltd. or Heiwa Iryo Kikai Co., Ltd.). When these instruments are used, however, at least one trocar is occupied. In addition, at present, these instruments are used only in very restricted situations.
X-ray contrast thread-containing gauze for laparotomy is also used for the absorption of blood and exudates in endoscopic surgery. In endoscopic surgery, however, it is difficult to frequently put gauze in and out through a trocar, and the replacement with new gauze is not easy, in contrast to laparotomy. In endoscopic surgery, therefore, blood and the like once absorbed in gauze is generally sucked through a suction tube, which is additionally inserted through a trocar, and the gauze is generally used again for the absorption of blood and the like. However, gauze is thin and relatively weak and therefore creates the risk of damage to an organ from the tip of a suction tube in the process of suction through the suction tube. In addition, gauze may adhere to the organ when dried, and the adhering gauze may cause damage to the organ when peeled off. It is also difficult to appropriately fold gauze in the abdominal cavity, which causes the disadvantage that it is difficult to protectively wrap or press an organ as in laparotomy.